Provider Demographics
NPI:1003218140
Name:LEZCANO, CELAIDA
Entity Type:Individual
Prefix:
First Name:CELAIDA
Middle Name:
Last Name:LEZCANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 E GRAY ST STE 670
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1901
Mailing Address - Country:US
Mailing Address - Phone:502-629-4525
Mailing Address - Fax:502-629-4529
Practice Address - Street 1:234 E GRAY ST STE 670
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1901
Practice Address - Country:US
Practice Address - Phone:502-629-4525
Practice Address - Fax:502-629-4529
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008957363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner